Clinic for General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstrasse 55, Germany.
Transpl Int. 2011 Jun;24(6):548-54. doi: 10.1111/j.1432-2277.2011.01232.x. Epub 2011 Feb 17.
The purpose of this study was to analyze the possible effects of machine perfusion (MP) versus cold storage (CS) on delayed graft function (DGF) and early graft survival in expanded criteria donor kidneys (ECD). As part of the previously reported international randomized controlled trial 91 consecutive heart-beating deceased ECDs--defined according to the United Network of Organ Sharing definition--were included in the study. From each donor one kidney was randomized to MP and the contralateral kidney to CS. All recipients were followed for 1 year. The primary endpoint was DGF. Secondary endpoints included primary nonfunction and graft survival. DGF occurred in 27 patients in the CS group (29.7%) and in 20 patients in the MP group (22%). Using the logistic regression model MP significantly reduced the risk of DGF compared with CS (OR 0.460, P=0.047). The incidence of nonfunction in the CS group (12%) was four times higher than in the MP group (3%) (P=0.04). One-year graft survival was significantly higher in machine perfused kidneys compared with cold stored kidneys (92.3% vs. 80.2%, P=0.02). In the present study, MP preservation clearly reduced the risk of DGF and improved 1-year graft survival and function in ECD kidneys. (Current Controlled Trials number: ISRCTN83876362).
本研究旨在分析机器灌注（MP）与低温保存（CS）对扩大标准供体肾脏（ECD）中延迟移植物功能障碍（DGF）和早期移植物存活率的可能影响。作为先前报道的国际随机对照试验的一部分，纳入了 91 例连续的心跳死亡 ECD，这些 ECD 根据联合器官共享网络的定义进行了定义。每个供体的一侧肾脏随机分配到 MP 组，对侧肾脏分配到 CS 组。所有受者均随访 1 年。主要终点是 DGF。次要终点包括原发性无功能和移植物存活率。CS 组 27 例（29.7%）和 MP 组 20 例（22%）发生 DGF。使用逻辑回归模型，MP 与 CS 相比显著降低了 DGF 的风险（OR 0.460，P=0.047）。CS 组的无功能发生率（12%）是 MP 组的四倍（3%）（P=0.04）。与冷保存肾脏相比，机器灌注肾脏的 1 年移植物存活率明显更高（92.3%对 80.2%，P=0.02）。在本研究中，MP 保存明显降低了 ECD 肾脏的 DGF 风险，并改善了 1 年移植物存活率和功能。（当前对照试验编号：ISRCTN83876362）。
